As a physician, I know how important it is to have access to my patient's health information.   As a patient, I know how frustrating it is to have my health information scattered across multiple doctors, ambulatory clinics and hospitals.  As a care manager for my elderly parents, I've experienced firsthand how difficult it is to keep track of their doctor appointments, medications, and medical problems.

Today, in Washington, D.C., Microsoft is announcing a new tool that will begin to bring order to this chaos.  It's called HealthVault; an environment of new online services to help people SEARCH, STORE and CONNECT their health information, putting them in control of  their, and their family’s health and wellness.

HealthVault, designed with security and privacy in mind, is built on the principle that people should have a copy of their own health information, have control over it, and be able to share their information with whomever they choose.  I think many people are going to proclaim, "It's about time!".

Using HealthVault, people will be able to store and control an array of health information, including prescription medication lists, health histories, hospital discharge summaries, lab results, fitness data and search results.

In addition to being a place to securely store and share personal health information, people can also use HealthVault to access and put to practical use a variety of new health services and home health medical devices.

Microsoft HealthVault Connection Center will make it possible for people to upload health-related data, such as that taken from blood-pressure cuffs, heart rate monitors, blood glucose monitors and peak flow meters. The technology is straightforward and makes it easy to confidently share health information with family, caregivers or physicians. With the support of partners that will develop these services and devices, Microsoft has committed to a platform that is free to consumers, inclusive of industry standards and trusted through robust privacy and security safeguards.

Speaking of privacy and security, I know that nothing is more important when it comes to your personal health information.  The HealthVault platform is underpinned by the following clear, strong health privacy commitments:

• The Microsoft HealthVault record you create is controlled by you.
• You decide what goes into your HealthVault record.
• You decide who can see and use your information on a case by  case basis.
• Microsoft does not use your health information for commercial purposes unless you are asked and you clearly tell Microsoft they may.

Rest assured, we know that transforming healthcare is an incredibly complex challenge – one which no single organization can solve alone. It will require the participation of leaders in every sector of the healthcare ecosystem if success is to be achieved.  However, with Microsoft's broad customer reach, extensive software platform and broad partner community, we believe that we have the depth and breadth required to help transform the way people and providers connect with health information and  services. 

You can learn more about today's launch of HealthVault by clicking on this video clip with Microsoft Health Solutions Group Corporate VP, Peter Neupert and Dr. Deborah Peel, founder of the Patient Privacy Rights Foundation.

I'm pleased to announce that more than 40 other innovative organizations – from leading medical providers, health management device manufacturers, and national health agencies are embarking with us on this challenge to bring the health industry into the Internet age.  We invite the rest of the health industry to join us. 

Bill Crounse, MD   Worldwide Health Director   Microsoft Corporation

 

Last April I posted a piece on this Blog entitled "If Disney Did Healthcare".  I commented that there was a lot the healthcare industry could learn from Disney about customer service, customer experience, and customer satisfaction.  It was one of those posts that generated a number of comments.  The following month, I posted a piece called "If Wal-Mart Did Healthcare" where I discussed some of the factors contributing to the rapid growth of the retail health clinic industry and its focus on customer relationship management, convenience, value, and price transparency. 

Yesterday, I received an e-mail from Jake Poore, President of a consulting firm called Integrated Loyalty Systems.   As soon as I read it, I just knew I had to share it with Channel 10 readers.  So, here it is: 
 

******************

Bill:

I enjoyed reading your April Blog regarding Disney and Healthcare, mainly because that is exactly what I chose to do in my life...translate Disney service and leadership principles into healthcare delivery of care. I went from the happiest place on earth to...well, healthcare (smile).

My career at Disney spanned nearly two decades and I created and managed the healthcare consulting team at the Disney Institute for 6 years, but it was obvious we were only allowed to be a benchmarking company and unable to help clients take it through fruition. Not anymore. For the past 6 years my team of ex-Disney and Southwest Airline execs have done just that. I invite you to visit my web site www.WeCreateLoyalty.com or call me so I can share many of the tools of how we are changing the face of healthcare one hospital at a time!

Kindest regards,
 

Jake
 

******************

So there you have it.  Hospitals can now learn from Disney (and Southwest) on how to transform their industry to better serve patients.  And yes, I know that healthcare with all its complexities, regulations, bizarre market dynamics, etc. is a very different business than theme parks or airlines.  But then again, some of the most dynamic and successful healthcare organizations, including many that I have personally had an opportunity to advise, have revolutionized  the way they do business by studying the best practices of other industries; Denver Health and Virginia Mason Medical Center being just two examples that come to mind.

And by the way, since contemporary information technology is such a vital component of the organizational transformation that is needed in the healthcare industry, I invite you to that conversation as well.  We have an entire team of folks who would be delighted to tell you more.

Bill Crounse, MD   Worldwide Health Director    Microsoft Corporation

Anyone who works in healthcare knows that many of today’s clinical software applications leave a lot to be desired when it comes to “user experience”.  Unlike ubiquitous, commodity software used in other businesses, healthcare applications are highly proprietary and often based on legacy technologies.  Clinicians find that much of what’s available today is often too hard to use.  Becoming proficient on these clinical applications requires lots of training and that can mean taking already scarce healthcare workers off-line for days or weeks at a time.  Worse yet, even if clinicians become proficient on one vendor’s solution, they are likely to encounter something entirely different in every hospital where they work, requiring even more training.  But what if there was a common, more standardized user interface for clinical applications?  What if the user experience was pretty much the same no matter where a clinician worked?  Would doctors, nurses and other clinical workers be better served?

Last July on this Blog I told you about an ambitious project to develop a standardized user interface to administrative and clinical systems.  The project was launched more than a year ago by Microsoft and the United Kingdom’s National Health Service.  It is part of a country-wide upgrade of the data spine, clinical and administrative applications used by the NHS.

Based on that work, Microsoft has launched  The Microsoft Health Common User Interface (CUI) web site.  It provides Design Guidance and controls that allow a new generation of safer, more usable and compelling health applications to be quickly and easily created. In this special video edition of my House Calls for Healthcare Professionals series, we take a look at the the work that's been going on at the NHS and how that work, through the MSCUI, now offers promise to improve worker satisfaction and patient safety around the world.  Enjoy the show!

Bill Crounse, MD    Worldwide Health Director      Microsoft Corporation

Downloads:  iPod,  MP3,  PSP,  WMA,  WMV,  WMV (High),  Zune

Program Guests

Dr. Mike Bainbridge is a former general medical practitioner who now leads the Clinical Architecture team at NHS Connecting for
Health, a group that delivers innovations in hardware design, clinical interface design and interfaces to the electronic medical record for both healthcare professionals and citizens.

Stephen Corbett is Head of UI Design for NHS Connecting for Health where he evangelizes the user-centred design approach to building software.  Since graduating in Ergonomics in 1988, he has been working in the field of software usability in various industries.

Andrew Kirby is a Director at Microsoft UK where he is responsible for the delivery of solutions and services to the National Health Service which includes the delivery of the Common User Interface Programme.

A little more than a year ago, I introduced Channel 10 readers to Azyxxi, Microsoft's unified health enterprise platform solution.  I also recorded an audio-cast with executives from our Health Solutions Group.  A few months ago, I updated you with another audio-cast featuring one of Azyxxi's early adopter customers, New York Presbyterian Hospital.  Today, Microsoft is announcing the addition of yet another well known hospital system to the growing list of Azyxxi customers; Novant Health.

Novant will implement Azyxxi throughout the enterprise, initially focusing on intensive care units and emergency departments and then expanding throughout its eight acute care hospitals and an 800-physician medical group.  With Novant and NY Presbyterian, early Azyxxi adopters now include 21 different hospitals at academic medical centers such as Johns Hopkins Health System; large health systems such as MedStar Health; and the Wisconsin Health Information Exchange, which will eventually tie together 25 different hospitals in Southeastern Wisconsin.

As we discussed in my most recent audio-cast, New York Presbyterian Hospital and its associated network is using Azyxxi to unify its existing and legacy information systems to create broad accessibility of its vast quantities of information. New York Presbyterian's senior vice president and CIO, Aurelia Boyer says, “As we’ve automated more and more of the processes within the hospital and created more electronic data sources, our ability to mine and utilize that data is becoming more of a priority. Making the data from different systems available in a way that makes good management, clinical and quality sense takes a lot of effort, and is a major goal for an institution like ours. Giving people in the hospital ready access to different kinds of data is priceless to us.”

Whereas New York Presbyterian is looking at Azyxxi as an administrative tool to guide organizational decisions, Novant Health is working to implement Azyxxi in support of its clinical operations.  “I’ve seen estimates that say a physician spends most of his or her time collecting information about the patient before they deliver the care,” says  Rich McKnight, Novant’s CIO. “Our goal is to dramatically reduce the amount of time in information gathering, and increase the amount of time in taking care of the patient.”
 
It has been my personal pleasure to attend many Azyxxi customer briefings with executives from our Health Solutions Group.  I can tell you that the solution is generating lots of excitement in the industry.  I also remember very well sitting with a senior finance executive at MedStar Health in Washington, D.C., as he was extolling the virtues of Azyxxi for revenue cycle enhancement and recovery.  The system gave Washington Hospital visibility to millions of dollars in high-value procedures and tests that were being improperly coded and therefore not collected by the hospital; millions of dollars that can now be spent delivering care to patients.
 
As Azyxxi liberates healthcare data from the constraints of silos and systems that don't "talk" to one another, I can only imagine the implications for providing cost and quality transparency in the industry, and our potential to improve the efficacy and efficiency of the care being provided by clinicians.

Bill Crounse, MD   Worldwide Health Director   Microsoft Corporation

While not every IT solution in healthcare clearly demonstrates results as stunning as those I'm about to share,  here's what I gleaned from a keynote presentation made by Dr. Paul St. Jacques earlier this week at the MSHUG Tech Forum 2007 in Redmond. Dr. St. Jacques shared the stage with me on day one of the conference.  I delivered the opening keynote, and he provided the close.

Dr. St. Jacques is Associate Professor and Director of Anesthesiology Informatics in the anesthesiology department at Vanderbilt.  Vanderbilt's perioperative information management system, VPIMS, serves as "master control" for the medical center's 60 operating rooms in 6 suites, handling thousands of surgical cases each year.  You may be surprised to learn that less than 5 percent of all surgeries in America are fully managed and documented electronically.  That's right.  In the year 2007, 95 percent of the "life and death" work-flow processes in surgery are still done on paper.

So what's to be gained by going electronic?  How about a 100 percent improvement in on-time cases starts, or a 90 percent compliance with perioperative antibiotic protocols resulting in an 1 percent decrease in surgical wound infections.  How about a 67 percent reduction in chart errors.  How about the average time to produce a billable chart moving from 12 days to 1, with a $1 Million plus improvement in formerly lost revenues.  Or how about a 10 percent yearly increase in case volume without adding capacity, keeping in mind that every additional case per day generates more than $1 Million in revenue per year.

 VPIMS handles everything from surgery scheduling, to perioperative documentation, to billing.  In addition, a module called Vigilance provides real-time monitoring of every operating room in the facility with multi-view streaming video, patient vital signs, alerts and reminders.  It might look like something out of Star Wars, but what it does for patient safety and staff satisfaction is priceless.  And did I mention there's a whole lot of Microsoft technology under the covers?

Greater detail on VPIMS is beyond the scope of my Blog.  Let me just say if you ever want proof that information technology in medicine saves lives and saves money, look no farther than the very fine work going on at Vanderbilt.  And yes, VPIMS has been so successful at Vanderbilt that the medical center is exploring options to commercialize and sell it.  And with 95 percent of the market still doing perioperative management on paper, they should have no problem finding customers.
 

Bill Crounse, MD  Worldwide Health Director   Microsoft Corporation 

PS  If you would like information about some of the other presentations at this year's MSHUG Tech Forum, my good friend and colleauge who serves as Microsoft's senior technical strategist for our worldwide health group, Roberto Ruggeri, provides play by play coverage on his Healthcare IT Blog.

I'd like to draw your attention to a new video that we've just released as part of my House Calls for Healthcare Professionals series.  The program takes a look at diagnostic software developed by Robertson Technologies.

I met Dr. Joel Robertson about five years ago.  I and others from Microsoft (most notably Dr. David Heckerman at Microsoft Research) have been advising Dr. Robertson during the development of his company's software.  The result of this work, NxOpinion, is one of the most significant, accurate, responsive and intuitive diagnostic programs I’ve seen.

I believe there are many applications for its use in emerging markets where physicians in rural villages or lesser-trained individuals working in public health need diagnostic support.  I believe there is also a role for diagnostic software in developed nations to improve patient safety and the quality of care in settings such as nurse call centers, community clinics, retail clinics, and urgent care settings.  There is also the potential for this technology to be used by consumers in evaluating personal health issues at home.

Enjoy the show! 

Bill Crounse, MD    Worldwide Health Director   Microsoft Corporation

See Video 

Do I think that some kind of universal, government-run healthcare fix is the answer to all of our problems? Absolutely not!  One of the things I have learned as I have traveled around the world these past few years is that providing timely, cost-effective, equitable healthcare for an entire population of people is challenging no matter what payment system is in place.  Healthcare is expensive and it doesn't matter whether the payor is government (we pay), employers (we pay) or private citizens (again, we pay); many of the miracles of modern healthcare have become so expensive and so out of the reach for people of ordinary means, there's just not enough money in any system to apply them universally and equally to every citizen.  Therefore, healthcare always has been and always will be rationed in some way.

So, if how we pay for healthcare has flaws no matter what system is in place, we must find better ways and better systems to deliver more affordable and accessible care.  I've taken a few hits for my positive stance on retail clinics, home health, patient self-service, physician-patient e-mail, personal tele-health services, and other modalities to provide health information and medical services in ways besides those that our current "system" provides.  Many of my physician colleagues are on a war path against retail clinics.  They are calling every state legislator and pulling out every tool in their regulatory armamentarium in an attempt squash the movement, but they will ultimately fail.  Prohibition doesn't work.  Retail clinics will thrive or falter based on the quality of services they provide and the value that their customers perceive.  The whole reason this movement has gained a foothold is because medical professionals haven't been listening to their patients.  Patients want healthcare to behave like other industries.  It really doesn't matter who's paying the bill.  We are all paying the bill, and we expect more than we have been getting considering how BIG that bill has become. 

Doing something about this will take more than coming up with new ways to pay for healthcare as it is presently delivered.  We need new care delivery models, staffing models, business models, and a bevy of contemporary information and communication technologies to truly revolutionize American medicine.  Neither Google, nor Microsoft nor any of the other companies mentioned in Lohr's article can be your doctor, nor should they be.  But these companies can and should help us with the technologies that will be needed to change the game.  If not Microsoft or Google, then who?

Bill Crounse, MD     Worldwide Health Director     Microsoft

I've mentioned before on this Blog that I'm a fan of Most-Wired Online and its guest editorials.  Every so often, a Most-Wired edition comes across my desk that especially draws me in.  This week's editorials by Senator Sheldon Whitehouse of Rhode Island on Building a National Health IT Infrastructure and by Lois Taveras and Dadong Wan of Accenture on The Case for Pervasive Healthcare really hit a chord with me.

I suppose we all tend to gravitate to folks who think like us, but I couldn't help but ponder how relevant these editorials are to some of the really big issues we face in American healthcare.

Senator Whitehouse is advocating for a public-private partnership akin to the COMSAT legislation for satellite communications during the Kennedy administration.  The partnership would drive interoperability, privacy and security rules, and EMR data standards for healthcare IT.  As I've hop-scotched around the world and seen for myself, America is woefully behind in the adoption of IT in healthcare (and don't even get me started on even more basic infrastructure failings like roads, bridges, airports, etc.). 

Taveras and Dadong write eloquently about the opportunity to transform healthcare delivery and services with pervasive technology that would help us better care for the elderly, treat people with chronic diseases, and frankly serve just about everyone else far more safely and efficiently than we do today.  Their editorial is a two-parter and I suspect next week's edition will deal with the harsh reality that unless we change reimbursement mechanisms and perverse incentives in American healthcare, these very real solutions will never see the light of day.  

Regular readers of my Blog will immediately understand why I embrace what these guys are saying.  Whether it is my commentaries on the potential for Unified Communications in Healthcare, Remote Physiological Monitoring, the need for a Common User Interface, the value proposition for Commodity Software in Healthcare IT, Failing American Infrastructure, and more; there is a very common theme.  And that theme is interwoven in everything Whitehouse, Taveras and Wan are writing about.

Wake up, America! If you think our foreign competitors don't see HUGE opportunities to beat us in healthcare because of our failings in IT and our screwed up system, think again.  We are at a crossroads here.  American healthcare as an industry is at risk of collapsing just like that freeway bridge in Minneapolis.  

Bill Crounse, MD   Worldwide Health Director      Microsoft

If your company ever comes to Redmond for a health industry briefing at our Executive Briefing Center, or you happen to attend one of the many keynotes I give at industry conferences throughout the year, you'll more than likely see what is known as our Health Future Vision video. 

This is the third such health industry video we have produced here at Microsoft.  It has been my pleasure to work closely with Ian Sands and his Industry Innovations Group (IIG) to bring these videos to life.  What's particularly interesting is how accurate the videos have been in predicting future industry trends and how technology will influence the way we work.  Perhaps that's because IIG does so much internal and external research before producing one of these videos.  We also base them on technology that is either currently available but not widely implemented, or on technology that is being actively pursued in the labs at Microsoft Research.  In any event, everything you see in the video is based on technology that is available now, or is very likely to be available within a 7 to 12 year time frame.

Our newest Future Vision Video also captures the essence of healthcare industry trends that I've been following and writing about for the last few years.  This includes the rising tide of consumerism in healthcare, the retail movement, commoditization of services, information everywhere, and globalization.

In the video, we follow a young pre-diabetic patient as she ventures out on a run. During her run, various physiologic functions are being monitored and data is being sent in real time to her personal health record. 

A case manager, who has been given permission by the patient to see her data, becomes aware that she may qualify for a new clinical trial.  When the young woman returns home she enters into a virtual consultation with her case manager who directs her to check with her personal physician about possible enrollment in the study.  She immediately schedules a "virtual conference" with her personal physician.

The scene switches to the young woman's endocrinologist as he beings to make rounds in a hospital.  He uses a very light-weight Tablet computer to gather information on his patients, locate needed equipment, and conduct his patient visits. 

 

We see him performing a retinal exam on one of his diabetic inpatients and sharing results with the patient. 

He later enters a special room where he conducts a "virtual visit" with the young woman we saw at the beginning of the video.  The physician, his patient, and a clinical researcher collaborate on details of the proposed clinical trial.

The doctor instructs his patient to visit a nearby retail setting, where as the video comes to a close, we see her using her "digital wallet" and a kiosk to get necessary tests and medication for the clinical trial.

I think the video accurately reflects the kind of consumer-directed, quality and price transparent, knowledge-driven healthcare delivery system we'd all like to see.  And while this is just a video, it certainly captures the essence for how information technology will help transform medical practice to better connect people and data, facilitate improved collaboration, and better inform everyone involved.

Bill Crounse, MD   Worldwide Health Director    Microsoft Corporation

Ten years ago I co-founded a company with the aim to provide web-based medical information, secure messaging and virtual visits between patients and their personal physicians. Working in partnership with Microsoft we developed technology that was well ahead of its time, and also well ahead of the market's ability to absorb it. Quite honestly, the technology was also a bit too complex, too expensive, and too hard to use. But that was then.

Roll forward ten years. The technology has matured. Governments and payors around the world are looking for ways to provide health information and medical services more efficiently. Shortages and mal-distributions of qualified medical professionals, aging populations, and the increasing burden of chronic disease are creating a perfect storm in healthcare. A medical model that is solely dependent on physicians providing care to patients one-on-one, in city center clinics or hospitals, doesn't scale anymore and certainly isn't sustainable.

Earlier this year I posted a Blog on Unified Communications: The Next Big Thing in Healthcare. If you didn't read it then, please read it now to become better grounded on what I'm about to share.

Envision a world where modalities for both synchronous and asynchronous communication begin to merge on the desktop, or even on your Smartphone. Imagine being able to schedule a virtual consultation with a colleague or colleagues as easily as you schedule an appointment in Outlook today.

Picture yourself using rich audio and video to enhance the communication and collaboration. Think about how you could share applications on your desktop, work together on documents, or extend presentations in a lecture hall to hundreds or thousands of your colleagues wherever they might be.

What about patients? Depending on your specialty this may be more or less relevant. However, I don't think there is a clinician out there who wouldn't benefit from incorporating Unified Communications into their practice work-flow. UC opens up amazing possibilities for virtual visits, follow-up visits, medication checks, home care, wound checks, chronic disease management, mental health, nurse call centers, patient education, and more. As governments and other payors around the world begin to understand the economics and value proposition of extending care with this now-commoditzed technology, healthcare services will go through a remarkable transformation.
 

With Microsoft Unified Communications, and the newest versions of Microsoft Office, Office Communicator and Office Live Meeting, all of this is not only possible; it is easy, intuitive and downright spectacular.

Use it as a hosted service or bring it into your enterprise. Do live interactive programs or record them for on-demand viewing later. There isn't a medical school, hospital, clinic, or physician's office that couldn't benefit from the mind-bending possibilities this technology unleashes. Get ready for a new day in healthcare.

Bill Crounse, MD Worldwide Health Director Microsoft Corporation

Are you a healthcare industry solution vendor? Do you want worldwide recognition for your company's good work and the solutions you build using Microsoft technologies? Would you like an opportunity to win prizes including a roundtrip for two to Paris and a guest spot to judge at the Imagine Cup 2008? If so, Microsoft's Developer and Platform Evangelist group (DPE) has started up a new industry solution showcase and contest that I believe will be of great interest to readers of my Blog on Channel 10.

For a little inspiration, visit the Microsoft ISV Showcase. You'll see some examples of the terrific work being done by our ISV community to change the world of healthcare (as well as education, clean technologies, and manufacturing). Check out the video from Vital Images, a company that is using Microsoft platform technologies as a base to give doctors a revolutionary new view of their patients, and a powerful way to save lives. The ground-breaking software creates colorful 3-D images from CT, MRI and PET scans, allowing problems in the heart, lungs, colon, and brain to be detected quickly, affordably, and less invasively. Also, take a look at some of the other healthcare ISV solutions that are featured in the showcase.

With that under your belt, jump to the CONTEST and enter your healthcare solution that is making, or has the potential to make, a difference in the lives of people around the world. Good luck!

Bill Crounse, MD    Worldwide Health Director  Microsoft Corporation

My colleagues at Microsoft Research asked me to spread the word about an announcement they made on Monday during their External Research & Program’s Faculty Summit. Faculty Summit is the premier event hosted by ER&P for academic researchers and professors to meet with Microsoft researchers and product group engineers for in-depth presentations and discussions of computing problems and research trends. The conference brings together approximately 350 academics from 175 leading institutions worldwide.

During the Summit, Microsoft Research outlined the research agenda for the next year by announcing 11 new RFPs. These are research grants open to anyone, two of which focus on healthcare (outlined below).

Cell Phone as a Platform for Healthcare

Goals:

· Explore applications and evolution of the cell phone for healthcare services.

· Incubate, develop, and disseminate to the worldwide academic research community new healthcare services prototypes and mobile technology tools.

Solution Statement: What medical applications are relevant, worldwide, for ‘smart’ mobile phones (application and web-enabled) in rural, and urban, communities? What are the appropriate services and infrastructures to be created to provide affordable and accessible healthcare services?

Personalized Medicine: Improving Genome-Wide Association Studies

Goal: Genome-Wide Association Studies (GWAS) is an area that would greatly benefit from having computing improvements for researchers. Focus areas for improvement include:

• Improvement of HapMap (tools for data collection, etc.)

• Standardization of genetic data collection, semantics and DB schema

• Improvement of Algorithms (particularly for in multi-allele disorders) accuracy, performance (e.g., parallelization, HPC)

• Genomic Data Visualization

Solution Statement: Genome-Wide Association Studies (GWAS) are defined by the NIH as any study of genetic variation across the entire human genome that is designed to identify genetic associations with observable traits (such as blood pressure or weight), or the presence or absence of a disease or condition. GWAS are laying the groundwork for personalized medicine. What is needed to put this data as quickly as possible into the hands of a broad number of researchers so that they can advance the state of the art in this area.

If you’re interested in any more detail, please contact Tami Begasse: tami.begasse@microsoft.com.

Here’s your chance to help change the world in healthcare.

Good Luck!

*****************************************************

Jim Lynch, R.N. is quoted by Health Data Management's on-line news service on remarks he recently made during a presentation at the 77th Convention and Exhibit of the American Health Information Management Association. In his address, "Electronic Medical Records: Expect the Unexpected", Mr. Lynch recounts the plaudits and pitfalls encountered at Oklahoma City-based Integris Health during the implementation of their EMR. He says, “A major part of the problem was that the electronic record was not easy to use--the interface is not as simple as Microsoft Word, and many physicians had absolutely no computer skills.”

Indeed! Why is it that EMR interfaces have to be so challenging for clinicians? The typical community physician in many American cities admits patients to more than one hospital. In my own community, it's not unusual for docs to call on three or four different hospitals. One hospital might use Meditech; another IDX; another Cerner; and yet another something else. Even if any one of these systems had the "perfect" user interface, how can a clinician become proficient on all of them? How much training would that take!

Bill Crounse, MD

******************************************************

I am now extremely pleased to tell you about something that I believe may be the tipping point in moving us toward a common user interface to clinical systems, perhaps worldwide. For the past couple of years, Microsoft has been working with administrators, clinicians and other experts in the United Kingdom to design a common user interface for clinical and administrative systems at the National Health Service. With the consent of the NHS and its Connecting for Health initiative, the design guidelines and tools are now being made available to developers around the world with the launch of the CUI Website.

As noted on the website, design guidance has been produced through a rigorous user-centred design process that incorporates primary and secondary research, usability testing, consultation with software providers and integrated hazard assessments. Patient Safety Assessments (PSAs) are continually performed to ensure the Design Guidance meets safety concerns.

The guidance is targeted at both existing clinical applications and those that are being designed and architected right now. The second part of this release is the implementation of much of that guidance in the form of control libraries for both WinForms 2.0 and ASP.NET. The website contains explanation and samples for each of the Web controls with the Codeplex project hosting a download of both the Winforms and the ASP.NET Control library.

Example of Common User Interface Design

If you are a developer of applications used in healthcare, an IT professional, or just someone who is passionate about clinical information systems, I urge you to become familiar with this excellent work, and help us make it even better by joining the dialogue here on CodePlex (http://www.codeplex.com/mscui). Take a look at the CUI Website and be sure to watch the introductory video.

My thanks to our Microsoft UK team and our colleagues at the National Health Service for providing leadership in addressing a much needed solution that will improve patient safety while providing a much easier to use, more consistent interface to clinical systems.

Bill Crounse, MD    Worldwide Health Director   Microsoft Corporation

Every so often we do a program in my House Calls for Healthcare Professionals series of audio and video-casts that really seems to hit the mark in demonstrating the value of Microsoft technologies in the healthcare industry. I want to draw your attention to one such program.

Arkansas Children’s Hospital is cutting edge when it comes to developing solutions on Microsoft technology. First, take a look at my Blog entry on this topic to get some background and then download or listen to our audio-cast with ACH to learn more about CarePoint and other solutions. This program is especially compelling because one of my guests is a patient at the hospital; a 16 year-old boy who has cystic fibrosis and has spent more time in the hospital than most of us can ever imagine. Find out how Microsoft technologies including Xbox 360, Media Center, Visual Studio, IE, and many others have come together to make hospital stays a whole lot more enjoyable for patients, their friends, and family at Arkansas Children’s Hospital.

Here is where you can stream the audio-cast or download it to your MP3 device

Arkansas Children's Hospital: IT Innovations Enhancing the Care of Hospitalized Children
This program is also available in MP3 for download.

Program Guests:

David Higginson is chief information technology officer at Arkansas Children's Hospital (ACH). He earned a degree in accounting/finance from Liverpool University and qualified as a Chartered Management Accountant. He began developing computer systems at the age of 10 and later combined his computer and financial expertise when he began developing systems for the Massachusetts Institute of Technology and the British Post Office. Since moving to ACH in 1996, Mr. Higginson has developed numerous award-winning computer systems with the help of his team of 14 developers, who have created more than 400 systems in less than five years.

Penny Ward is a registered nurse who joined Arkansas Children's Hospital in 1993. Since 2002 she has been a Nursing Director for the Adolescent and General Medicine units and for the Dialysis and IV teams at the hospital.

Christopher Holstead is 16 years old and has cystic fibrosis. He has been admitted to Arkansas Children's Hospital many times and has seen how the hospital has improved the patient care experience.

Additional resources

Healthblog - additional information and screenshots of ACH CarePoint patient entertainment/education solution

Arkansas Children's Hospital

Windows XP Media Center

Xbox

Bill Crounse, MD   Worldwide Health Director   Microsoft Corporation

Back in April I posted information on HealthBlog about Medstory, the medical search company that had recently been acquired by Microsoft. I interviewed Medstory founder and CEO, Dr. Alain Rappaport, who I have known for nearly a decade. Alain and I first met while I was co-founding a venture-backed technology company aimed at facilitating physician-patient communication and collaboration. Little did we know at the time that many years later our paths would cross once again under Microsoft's umbrella.

Dr. Rappaport called me last week to say that Medstory is now fully integrated with MSN’s Health and Fitness site. He wanted me to be among the first to know and invited me to take it for a test drive.

After navigating to MSN Health and Fitness, I initiated a search on Prostate Cancer. Right away, I noticed that my search yielded Medstory's unique and rather colorful “dashboard".

The dashboard is made up of categories. Under each category is a list of related health topics that are most pertinent to the search being performed. The color bar next to each topic illustrates its degree of relevance to the subject of the search. For instance, one of the categories for a search on Prostate Cancer is Tests and Procedures. The most relevant topic in that category is the PSA Test. When I click on PSA Test, I have the option of refining my search to include both Prostate Cancer and PSA Test, or PSA Test alone.

Should I decide to search for both terms, the most pertinent articles containing both terms will be revealed. I'm given similar choices each time I conduct a search adding a third, fourth, or fifth term to my list. I also have the option of jumping to articles that are associated only with the new term I'm selecting from the dashboard. I also have the choice of using a "Site Search Results" tab that only reveals articles on MSN, or "Health-Related Web Results" that will return health information from all across the worldwide web. Note that the categories include Complementary Therapies and Nutrition; two that will be especially popular with consumers.

Prior to founding Medstory, Dr. Rappaport had had an illustrious career in artificial intelligence research and data mining. He says he turned his attention to improving how consumers and clinicians find and use medical information because healthcare is an industry that is driven by information. It is not enough, he says, to provide links to information. Search engines must become intelligent enough to understand a user’s intent. “We need a web that knows versus one that just links”, said Dr. Rappaport. “We are moving the center of gravity of search to return an understanding of what the user wants. Our core objective is to provide meaningful information that is also actionable.”

Dr. Rappaport said he teamed up with Microsoft because of the opportunity to engage with customers and partners all around the world who are now coming forward to help us innovate and use this technology. “Even in parts of the world where populations are medically underserved", he said, "providing relevant and timely information, will make a difference”.

Of course, this is just the beginning of many health related applications and services for both consumers and medical professionals that you'll be seeing from Microsoft and our partners in the months and years ahead. But for now, the next time you are seeking information about health or wellness, navigate over to MSN Health and Fitness and take Medstory for a spin. I think you will like what you see.

Bill Crounse, MD   Worldwide Health Director   Microsoft Corporation

As I read the article, I couldn't help but think about a conversation I had just had with a colleague who currently serves as a hospital CIO. He expressed to me his total frustration with hospital culture and healthcare providers. In fact, he is so frustrated that after ten years on the job he is looking for another position; this time likely in another industry.

His hospital had recently purchased a very advanced surgical management system that included anesthesia scheduling and work-flow automation. The anesthesiologists at first welcomed these new tools, although one of the docs had initially pushed back because he had designed his own solution that he thought was a lot better than the vendor solution selected by the hospital.

Even so, after a few weeks using the new system, several of the older and most influential members of the anesthesia group simply proclaimed that they didn’t like what the hospital had purchased and would be going back to using their old paper processes. And, as my colleague noted, "that was that".

A similar scenario had recently played out in the radiology department. The mammography unit was asked to start using the hospital's digital PACS system. They prepared the docs for the fact that their productivity could initially fall by as much as 30 percent until they got used to the new tools and work-flow. The docs agreed to give it a try, but as soon as their productivity actually did take a nose-dive, they rebelled and refused to use the new system.

I know what you may be thinking. Screw the doctors! Tell them they have no choice but to use the new systems. As a doctor and a former hospital VP/CIO and CMIO, I know it's not that easy. Those doctors are the life blood of the hospital. It took years to recruit the physicians who run the mammography unit. And the anesthesiologists? They along with their powerful surgeon allies are responsible for most of the hospital’s profit margin.

The CIO also told me about his hospital's struggle to implement an electronic charting system in nursing. He said the VP of Nursing gives the initiative good lip service, but her first in command is a 50 year old nurse who has never worked anywhere else, and there’s a lot of passive-aggressive behavior going on in the rank and file. Since the nurses are all employees, you might think administrators could just lay down the law and mandate the use of the nursing documentation system. But you would be naïve to think that. The average age of nurses working at the hospital, especially as managers and unit leads, is 50-plus. There’s a huge nursing shortage with lots of vacancies in posted positions. They have a powerful union. It’s hard to tell them what to do.

I share this because it is so typical of the culture in healthcare, and not only here in America. It speaks volumes on the issue that Gartner is drawing to our attention; it isn’t so much about the technology as it is about the culture, and the need for more carefully orchestrated change management.

Of course some of these hassles will resolve as the “dinosaurs” retire. But based on what Gartner is saying the age and culture issue won't go away. Instead of “why must I use this computer instead of my paper” the argument will become “why must I use this (fill in the blank) instead of my computer"?

Bill Crounse, MD     Worldwide Health Director      Microsoft

Arkansas Children’s Hospital

That is exactly what has happened at Arkansas Children’s Hospital. ACH is based in Little Rock. It is the only full-service children's hospital in the state. The staff at ACH decided it was time to replace the hospital's aging in-room television system with something a little more contemporary. At first, they looked at systems that might typically be found in good hotels. However, they soon discovered that these systems were too expensive, too inflexible, and too limiting for what they really wanted to accomplish. They wanted a system that would provide their young patients with a full spectrum of on-demand movies, television, Internet, video gaming, and patient education. They also wanted a highly flexible platform on which they could provide other services now and well into the future. Finally, they wanted complete control over the system and its attributes that could be fine-tuned to meet the age-appropriate needs of patients, their friends and family. When they didn't find what they needed on the open market at a price they could afford, they decided to build it themselves.

The solution they came up with uses Microsoft Media Center, Xbox 360, and SQL Server. It extends the hospital's IT infrastructure out to the patient's bedside. Patients access the system through a custom designed interface on a 15-inch flat screen monitor next to the bed. This set-up lends itself to easy cleaning between patients. The monitor also becomes a kind of "command-central" for doctors and nurses who want to access a patient's electronic record or review x-rays and other data with the patient in his or her room. Movies, games, educational videos, Internet access, e-mail, messaging, etc. are viewed on a 32-inch LCD screen mounted on the wall across from the bed.

Home screen to the bedside entertainment and education system at Arkansas Children's Hospital based on Microsoft Media Center

Yesterday, I recorded one of my House Calls audio-casts with the staff at ACH. That program will be posted on my House Call's site on Microsoft.com within the next few days. In the meantime, I just couldn't wait to tell you about this. Although the solution has just finished a limited pilot, the decision has already been made to roll it out hospital-wide. One of the highlights of my audio-cast was interviewing a 16 year-old young man who is a frequent patient at ACH. To hear his excitement about using the new bedside entertainment and education system at ACH was reward in itself. He said the system is totally awesome in helping him stay in touch with school, friends and family during extended hospital stays. His doctor has used the bedside monitor to review test results with him. And the TV, movies and Xbox games are way cool!

Custom user interface that controls entertainment and education options as displayed on a 15-inch flatscreen monitor at the patient's bedside

Congratulations to ACH Chief Technology Officer, David Higginson, and his staff. This is just one of more than 400 clinical and business solutions this team has built at Arkansas Children's Hospital in the last five years alone. I met David a while back when he visited us here at Microsoft in Redmond. It was evident then that he and his team were up to some amazing work. My thanks also are extended to Penny Ward, RN, for sharing her enthusiasm about the bedside solution at ACH. And, my very special thanks go to Christopher Holstead, the 16 year-old patient at ACH, for sharing his thoughts about the new bedside entertainment and education system.

Be watching here on HealthBlog for more information when my House Calls’ audio-cast with Arkansas Children’s Hospital goes live on the Net.

Bill Crounse, MD   Worldwide Health Director   Microsoft

The first week of June, I visited another hospital that has taken a similar approach. The hospital, Hospital de São Sebastião, is located about 30 kilometers outside of Porto, Portugal and services a total population of about 383,000 people. I visited Porto to speak at our EMEA Health Leader's Forum. The first day of the two-day event, we were treated to a tour of Hospital de São Sebastião provided by the hospital's CEO, Dr. Hugo Meireles; CIO, Rui Gomes; Internist, Dr. Luis Pedro, and ER physician, Dr. Jorge Teixeira.

Hospital de São Sebastião is a 317 bed, acute care and trauma facility built in 1999. From the very beginning, hospital planners wanted an organization that would be a significant cut above other public health hospitals in Portugal. Rather than buy a hospital information system, CIO Mr. Rui Gomes and his small but dedicated staff of 11 full-time employees set out on a quest to build the IT foundation, business, and clinical applications that would best serve the hospital and the people who worked there. It has been an iterative project that appears to be serving hospital workers and the patients they care for extremely well.

Internal Medicine specialist Dr. Luis Pedro shows me how he accesses patient information and documents his work while caring for patients at Hospital de São Sebastião located just outside of Porto, Portugal.

Over the years I have toured some of America's so-called "most wired" facilities. In fact, the Seattle area hospital where I served as Vice President, CIO and CMIO for many years was often cited in that most-wired category of leading American institutions. But quite honestly, I must say that I have rarely toured a hospital where I have seen physicians so seamlessly using information technology as I observed during our tour of Hospital de São Sebastião. This is all the more remarkable when one considers that they built most of the solutions they are using all by themselves. And, they did it using commodity software that costs just pennies on the dollar compared to equivalent solutions used in US hospitals.

Doctors roamed the halls with Fujitsu Tablet PCs while wirelessly connected to the hospital's network. They had complete access to all patient data including imaging, lab results, etc., and they performed all of their charting from admission to discharge electronically.

Screen shot of HIS solution in use at Hospital de São Sebastião

Nurses and other caregivers also used the hospital information system. In the emergency room, an electronic triage system not only helped to prioritize treatment, but timed and tracked exactly how that treatment was delivered; sending gentle reminders to staff whenever patients were left waiting longer than necessary

Screen shot of ER triage application at Hospital de São Sebastião

To be fair, the system didn't have all the bells and whistles that might be found on big vendor solutions used in American hospitals. CPOE was still a work in progress although doctors were using an electronic prescribing solution. But that is precisely my point. The system was designed to do exactly what the staff really needed most. It has an interface and tools that make it intuitive, fast, and highly functional. What it lacked I would place in the category of "nice to have" rather than "have to have". And perhaps that is why the home-built HIS solution in use at Hospital de São Sebastião is so popular with physicians and other caregivers at the hospital.

In case you are wondering, some of the Microsoft products and solutions IT professionals used to build the HIS at Hospital de São Sebastião include; Active Directory, SQL Server 2005, SharePoint Services, SQL Reporting Services, Balanced Score Card Manager, ISA Server, BizTalk, Exchange, .Net Framework, and Visual Studio 2005.

My congratulations to Rui Gomes, his IT staff and caregivers at Hospital de São Sebastião!

Bill Crounse, MD   Worldwide Health Director   Microsoft Corporation

Everywhere I go, I get questions about Microsoft's acquisition of a technology and company known as Azyxxi from MedStar Health in Washington, D.C.. Last summer, shortly after the acquisition took place, I invited company founders and Microsoft executives to join me in an audio-cast discussion about the technology and why it attracted Microsoft's attention. Since then, there's been a great deal of speculation about who the first customer or customers might be.

Azyxxi is a unified health enterprise platform that helps improve cross-organizational access and insight to clinical, administrative, and financial data. It was recently announced that New York Presbyterian Hospital, the nation's largest not-for-profit, non-sectarian hospital, selected Microsoft Azyxxi. A short time later it was revealed that Johns Hopkins Hospital and Medical Center will also be an early customer and development partner for Azyxxi.

In this edition of my House Calls for Healthcare Professionals audio-cast series, we get an update on what has happened since last summer, and explore why a prestigious hospital system like New York Presbyterian decided to implement it.

To listen to the program, click on the links below:

Microsoft Azyxxi update: Development partner and first customer
This program is also available in MP3 for download.

Panel guests

Yesterday, Microsoft officially launched the first commercial product from a group and technology known as Microsoft surface computing. The product is called Milan; a coffee-table sized PC that takes touch screen technology to entirely new levels and gives users a highly interactive experience with all things digital. For now, you'll be seeing the technology in business environments such as hotels, casinos, and retail establishments. You can read more about that here:

I first told you about surface computing last July when I met with colleagues at Microsoft Research to produce a video segment for my House Calls for Healthcare Professionals series. In that video, Dr. Eric Horvitz and surface computing guru, Andy Wilson, and I talked about the technology and possible implications for the healthcare industry. At the time Andy's work was going under the code name Play Anywhere. My head was literally spinning with ideas on how this new user interface could be used in radiology, physical therapy, anatomical pathology, and other disciplines. It also occurred to me that this new way to interact with a computer, manipulate screen images, and navigate through data could be immensely important to clinical work-flows demanding a more hands-free, no-touch solution such as might be desirable during surgery or certain medical procedures.

If you are a developer of solutions for the healthcare industry, or just an enthusiast of forward-looking technologies, you may want to give my video another look. You may also want to view another video that was shot during an “In the Labs” keynote panel at the Gartner ITXpo at the Moscone Center in San Francisco. In the video, broadcast by CNET, Dr. Eric Horvitz also ponders possible medical uses for surface computing. Finally, if you take a look at another video I recently did with UCSF physician and CMIO, Dr. Michael Blum, and Motion Computing VP, Joel French, you'll catch us talking about the touch screen features found on Motion Computing's newest Tablet PCs running Windows Vista. Put two and two together, and I think you'll begin to see where all this is going.

I would like to extend my congratulations to Andy Wilson and his fellow researchers at Microsoft Research, as well as to my colleagues in our surface computing group. Way to go! I can't wait to see how some of our partners in the healthcare ISV community will take advantage of surface computing in tomorrow's clinical applications.

Bill Crounse, MD   Worldwide Health Director   Microsoft Corporation

Over the past few years Microsoft partner, Motion Computing, has focused on serving the healthcare industry. In February at HIMSS, the company introduced an entirely new category of Tablet PC; the Mobile Clinical Assistant, also known as the C5. In March, Motion introduced a new full-sized Tablet PC, the LE1700. It not only offers a touch screen for data input but is also fully capable of running Windows Vista with Aero glass graphics.

In this special video edition of my House Calls for Healthcare Professionals series of streaming audio and video programs, I’m joined by Joel French, VP for Motion Computing, and Dr. Michael Blum, VP and CMIO of UCSF Medical Center. We take a first look at these exciting new Tablet PCs and discuss how these devices are being used by clinicians around the world.

If you’re thinking about Tablet PCs for your hospital or clinic, you’ll want to watch this 20-minute video program featuring the newest devices now on the market. To watch the video, just click HERE

Bill Crounse, MD Worldwide Health Director Microsoft Corporation

Program Guests:

Joel French, is Vice President of the Health and Life Sciences group for Motion Computing, Inc. Mr. French is a leader in wireless products and services designed for mobile professionals in vertical industries.

Dr. Michael Blum, is Associate Clinical Professor of Medicine, a practicing Cardiologist, and Chief Medical Information Officer for the University of California San Francisco Medical Center.

It's ironic that this interview was released while I'm attending the first-ever Asia-Pacific HIMSS conference in Singapore. Last evening, I met with several clinicians who were telling me how tele-medicine and e-mail are being embraced by clinicians and patients all across this country, especially for primary care. As you may know, Singapore has a very progressive public-private healthcare system that serves the population extremely well at a cost to the GNP that is only one third of what we spend in the US.

As I travel the world, not only am I seeing more progressive use of information technology in healthcare compared to the US, I'm just plain seeing lots of technology everywhere that we don't have. Even the taxi cabs here are marvels of IT on wheels. Want to charge your cab ride using a credit card? No problem. Want a GPS-enabled turn by turn tour of the town? Got it. Want the cab's computer to calculate your fare and then explain it to you in your native language? Done! Oh, I did I tell you about the cell phones people use here that are years more advanced than anything you'll see in the US, or that my hotel room has a 42-inch fully digital, high definition LCD TV with more than 100 channels? I think you get the idea.

Better wake up America before it's too late! An electronic health record for most American's within ten years (now just seven years since that proclamation was made)? They already have that in Singapore. And tomorrow? Well, let's just say officials here and elsewhere around the world see a very big market for delivering healthcare to Americans who are either willing to travel for it, or better yet, want to receive a least a portion of their care on-line.

Bill Crounse, MD  Worldwide Health Director  Microsoft Corporation

In previous HealthBlog entries, I've told you about the growing trend of hospitals using commodity software to run the enterprise including electronic medical record systems based on Microsoft standard products. Most of these examples come from outside the United States where perhaps there's more emphasis on spending precious public funds wisely. Most recently I profiled Torrevieja Salud hospital in Spain as an example of this trend. You can read more about what they did by clicking here.

One of my colleagues sent information about a public hospital system in Switzerland that has taken a similar approach to implementing electronic patient records. The hospital system is Solothurner Spitäler AG, a consortium of canton Solothurn's six public hospitals that are located in different locations across the region and are now centrally managed.

The healthcare system had been relying on a rudimentary electronic patient record solution built with Filemaker. It had been developed by the hospital’s own enterprising doctors and programmers. After reaching a size of some 75,000 patient records, the homegrown solution was becoming unstable and programmers realized it wouldn't scale for the future. Working with a local IT consulting company, afca informatik, the hospital system settled on a centralized electronic patient record solution based on XML. It is accessed by web services and uses Microsoft Office InfoPath on the client side. The solution is called INFOPath-DOC.

Speaking about the solution, Dr. Pascal Walliser, CIO for Solothurner Spitäler AG said, “INFOpath-DOC gave us a new foundation for an electronic patient record solution based on Microsoft standard products. It is an effective, reliable tool that supports everyday administrative work in our hospitals. At the same time it has given us a platform to develop innovative solutions that will allow us to go even further in our efforts to deliver consistently patient-oriented medical services.”

As the world embraces open standards and the advantages of XML web services, could such solutions in hospitals and clinics become more common? When one considers the fiscal constraints of our healthcare institutions and their primary mission to deliver the highest quality of care at the lowest possible cost, it seems like a reasonable assumption. Why would you spend hundreds of millions of dollars on an IT system when much lower cost and frankly much more contemporary solutions can be built using commodity components? Food for thought!

Bill Crounse, MD    Worldwide Health Director   Microsoft Corporation

In addition, Wal-Mart, Intel and other major employers have announced their intent to provide a transportable personal health record for employees. In fact, the retail health movement which includes organizations such as MinuteClinic and RedClinic, is very focused on using technology to improve care quality and safety as well as to enhance the "patient experience". Price transparency, a factor that is all but absent in services offered in traditional care facilities, has become a hallmark for the retail movement. Likewise, retail clinics go overboard when it comes to savvy marketing, customer relationship management, and patient convenience. And although organized medicine has taken some pot-shots at the clinics, patients seem to love them.

Where is all this going? I think the trend is generally healthy. People want affordable, convenient, high quality care. They are demanding more value for their healthcare dollar. They are looking for a healthcare industry that behaves more like other industries; one that is responsive to market forces and customer demands offering cycles of continuous quality improvement, improved productivity, and lower costs. As my colleague John Goodman of the National Center for Policy Analysis points out, healthcare would behave like other industries were it not for the perverse effects of traditional insurance programs on the supply side of the business. He writes;

Suppose we passed a law tomorrow prohibiting all insurance companies (including Medicare and Medicaid) from paying any medical bills less than $5,000. What would happen? The medical marketplace would transform almost overnight. Within a couple of months, there would be no such thing as a primary care physician (PCP) who did not post prices - at least for routine procedures. PCPs would offer telephone and email consultations. They would keep patient records electronically (just like lawyers and accountants). Overall, there would develop a teeming, bustling, entrepreneurial marketplace for primary care, diagnostic tests and most prescription drugs. Specialty markets would develop for the chronically ill, as doctors competed for their business instead of trying to avoid them. Patient education would become an emerging field, with providers offering to teach diabetics, asthmatics, etc. how to manage their own care. Internet drug sales would double, triple and quadruple, as brand drugs faced increasing competition from generic, therapeutic and over-the-counter substitutes. At the same time, overall health care spending would plummet.

What if Wal-Mart did healthcare? Yeah. What if?

Bill Crounse, MD   Worldwide Health Director   Microsoft Corporation